Nurses' views on the characteristics of an effective leader

AORN Journal,  Feb, 2008  by Arta Feltner,  Barbara Mitchell,  Elfi Norris,  Clara Wolfle

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Leading a department or an organization is not an easy task, but effective leadership is critical to an organization's success. Effective leaders can create a working environment in which staff members are satisfied and productive in their jobs and positively contribute to the success of the organization. Ineffective leadership, however, can result in a loss of morale and productivity among staff members and ultimately have a negative impact on outcomes for the organization.

Flagler Hospital, St Augustine, Florida, is a 316-bed acute care facility that has achieved Magnet status. Because of their Magnet philosophy and practice, nurses at Flagler Hospital view the leadership role as being nurse-defined and nurse-directed. Consequently, a team of four RNs at Flagler Hospital decided to undertake a descriptive survey project to determine what characteristics staff nurses considered to be the most important and desirable in a leader.

DEFINITION OF TERMS

The project team determined that it was essential to have set definitions for certain terms that would be used during the project. In this project, the term leader refers to a person who leads; this can be a person in a managerial position or a staff nurse who is involved in change, innovation, growth, and empowerment of staff members and others. (1)

Based on definitions the team members reviewed in the literature, the term leadership in this project refers to an interpersonal process for influencing the actions of an individual or group toward accomplishing goals in a given situation. (2) Leadership is defined as setting the pace and the direction for change; facilitating innovative practice; and ensuring that policies are up to date, professional standards are set in relation to care, and a comprehensive service is developed over time. (3) Nursing leadership has been described as a vehicle through which health policy and nursing practice can be influenced and shaped. (4)

THE INTERVIEW SEGMENT OF THE PROJECT

The first part of the project involved interviewing RNs regarding their perceptions of the characteristics of an effective leader. The project team developed an interview question that was open-ended and concise: "What do you consider to be desirable qualities or characteristics of an effective leader?"

The project team sent a letter to all 70 RNs in the Surgical Services Department at Flagler Hospital (ie, those working in outpatient services, preoperative holding, the OR, and the postanesthesia care unit) asking them to participate in the project. The letter included a contract for participation, which outlined the intent of the interviews and the time allocated for each interview and guaranteed the anonymity of the nurse participants.

The four project team members conducted one-on-one interviews with a total of 40 nurse participants. The interviewers took notes during the conversations and interpreted the characteristics discussed by each participant. The interviewers payed special attention to the use of key words from a list of defined characteristics they had developed based on both a literature review and a brainstorming session (Table 1). The interviewers also interpreted the participants' ranking of the importance of each desirable characteristic that they discussed.

In addition to asking participants the open-ended interview question, one of the project team members provided eight of her interviewees with the list of key words that the interviewers had developed, and she asked the participants to rank each characteristic in order of importance. She noted that among these participants, only one mentioned the word "motivation" during the discussion, but a majority of the participants ranked motivation as the most important characteristic for a leader to possess when they ranked the list of characteristics. Based on this finding, the project team concluded that the interview data collection method was subjective and open to interpretation by the interviewers. The team decided to implement a second stage of the project to collect a more objective ranking of desirable characteristics of an effective leader.

THE SURVEY SEGMENT OF THE PROJECT

The project team designed an objective survey tool for determining which characteristics RNs considered most important for a leader to have. The project team members created a list of characteristics based on the information they had collected during the 40 interviews and distributed this list to all 70 RNs in the Surgical Services Department (Figure 1). They asked that respondents rank the characteristics of an effective leader in order of importance, with 1 indicating the most important characteristic and 15 indicating the least important characteristic.

FIGURE 1

Survey Form to Rank Characteristics of an Effective Leader

Instructions: Please rank the following qualities and characteristics
of an effective leader in order of importance, with 1 = most important
and 15 = least important.

--Communication skills--is honest, open, approachable, a good listener;
maintains confidentiality

--Compassionate--is understanding, respectful of others

--Confident--is decisive, firm, able to identify and address problems
as they arise, able to make hard decisions for the overall good of the
department, open to input and ideas from others, a problem solver

--Delegation--uses personnel resources effectively, gives up some
control

--Dependable--is reliable, consistent

--Employee loyal--takes care of employees, is dedicated, puts himself
or herself on the line for employees

--Fairness--is objective when dealing with issues, remains neutral,
treats everyone equally, is nonjudgmental, shows no partiality

--Flexible--is able to use resources effectively

--Job knowledge--has an understanding of all job descriptions and
responsibilities of the employees under his or her direction, keeps
up to date on continuing education, can give answers or directions to
find answers or solutions

--Motivating--promotes a sense of responsibility, encourages employees
to be the best they can be, helps employees to excel, empowers
employees, is inspirational

--Negotiator--promotes cohesiveness, is able to bring a split group
back together

--Participative partnership--"walks the talk," leads by example,
promotes teamwork by pitching in, is a team player

--Positive attitude--smiles; has a good sense of humor; has good people
skills (ie, is interactive); elevates morale using positive
reinforcement

--Role model--has good moral character and good ethics, is trustworthy
and professional

--Sets objectives--sees the "big picture," sets goals and standards,
points the department in a good direction, has a plan to implement